|
CT PELVIS W/DYE
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 72193 TC
|
| Hospital Charge Code |
4220042
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$978.25 |
| Max. Negotiated Rate |
$978.25 |
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Galaxy Health Commercial |
$978.25
|
|
|
CT PELVIS W/O DYE
|
Facility
|
IP
|
$1,413.00
|
|
|
Service Code
|
HCPCS 72192 TC
|
| Hospital Charge Code |
4220040
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$918.45 |
| Max. Negotiated Rate |
$918.45 |
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: Galaxy Health Commercial |
$918.45
|
|
|
CT PELVIS W/O DYE
|
Facility
|
OP
|
$1,413.00
|
|
|
Service Code
|
HCPCS 72192 TC
|
| Hospital Charge Code |
4220040
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$211.95 |
| Max. Negotiated Rate |
$1,130.40 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$649.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$565.20
|
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: Cash Price |
$1,059.75
|
| Rate for Payer: CDPHP Medicare |
$522.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$989.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,130.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,130.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,130.40
|
| Rate for Payer: EmblemHealth Medicare |
$480.42
|
| Rate for Payer: EmblemHealth Select Care |
$918.45
|
| Rate for Payer: Fidelis Medicare |
$565.20
|
| Rate for Payer: Galaxy Health Commercial |
$918.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$565.20
|
| Rate for Payer: Humana Medicare |
$565.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$649.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,059.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$795.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$593.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$211.95
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$565.20
|
| Rate for Payer: WellCare Medicare |
$777.15
|
|
|
CT PELVIS W/O DYE
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
HCPCS 72192 26
|
| Hospital Charge Code |
5220040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$103.35 |
| Max. Negotiated Rate |
$103.35 |
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Galaxy Health Commercial |
$103.35
|
|
|
CT PELVIS W/O DYE
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
HCPCS 72192 26
|
| Hospital Charge Code |
5220040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$23.85 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$73.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$63.60
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: CDPHP Medicare |
$58.83
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$127.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$127.20
|
| Rate for Payer: EmblemHealth Medicaid |
$127.20
|
| Rate for Payer: EmblemHealth Medicare |
$54.06
|
| Rate for Payer: Fidelis Medicare |
$63.60
|
| Rate for Payer: Galaxy Health Commercial |
$103.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$63.60
|
| Rate for Payer: Humana Medicare |
$63.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$73.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$119.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$89.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$66.78
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$23.85
|
| Rate for Payer: United Healthcare Medicare |
$63.60
|
| Rate for Payer: WellCare Medicare |
$87.45
|
|
|
CT PELVIS W/O & W/ DYE
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
HCPCS 72194 26
|
| Hospital Charge Code |
5220041
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$26.70 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$81.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$71.20
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: CDPHP Medicare |
$65.86
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$142.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$142.40
|
| Rate for Payer: EmblemHealth Medicaid |
$142.40
|
| Rate for Payer: EmblemHealth Medicare |
$60.52
|
| Rate for Payer: Fidelis Medicare |
$71.20
|
| Rate for Payer: Galaxy Health Commercial |
$115.70
|
| Rate for Payer: Hamaspik Choice Medicare |
$71.20
|
| Rate for Payer: Humana Medicare |
$71.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$81.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$133.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$100.21
|
| Rate for Payer: MVP Health Care of NY Medicare |
$74.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$26.70
|
| Rate for Payer: United Healthcare Medicare |
$71.20
|
| Rate for Payer: WellCare Medicare |
$97.90
|
|
|
CT PELVIS W/O & W/ DYE
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
HCPCS 72194 26
|
| Hospital Charge Code |
5220041
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$115.70 |
| Max. Negotiated Rate |
$115.70 |
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Galaxy Health Commercial |
$115.70
|
|
|
CT PELVIS W/O & W/DYE
|
Facility
|
OP
|
$2,381.00
|
|
|
Service Code
|
HCPCS 72194 TC
|
| Hospital Charge Code |
4220041
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$357.15 |
| Max. Negotiated Rate |
$1,904.80 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,095.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$952.40
|
| Rate for Payer: Cash Price |
$1,785.75
|
| Rate for Payer: Cash Price |
$1,785.75
|
| Rate for Payer: Cash Price |
$1,785.75
|
| Rate for Payer: CDPHP Medicare |
$880.97
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,666.70
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,904.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,904.80
|
| Rate for Payer: EmblemHealth Medicaid |
$1,904.80
|
| Rate for Payer: EmblemHealth Medicare |
$809.54
|
| Rate for Payer: EmblemHealth Select Care |
$1,547.65
|
| Rate for Payer: Fidelis Medicare |
$952.40
|
| Rate for Payer: Galaxy Health Commercial |
$1,547.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$952.40
|
| Rate for Payer: Humana Medicare |
$952.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,095.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,785.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,340.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,000.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$357.15
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$952.40
|
| Rate for Payer: WellCare Medicare |
$1,309.55
|
|
|
CT PELVIS W/O & W/DYE
|
Facility
|
IP
|
$2,381.00
|
|
|
Service Code
|
HCPCS 72194 TC
|
| Hospital Charge Code |
4220041
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,547.65 |
| Max. Negotiated Rate |
$1,547.65 |
| Rate for Payer: Cash Price |
$1,785.75
|
| Rate for Payer: Galaxy Health Commercial |
$1,547.65
|
|
|
CT PERFUSION W/ CONTRAST CBF
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
HCPCS 0042T 26
|
| Hospital Charge Code |
5220076
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$190.45 |
| Max. Negotiated Rate |
$190.45 |
| Rate for Payer: Cash Price |
$219.75
|
| Rate for Payer: Galaxy Health Commercial |
$190.45
|
|
|
CT PERFUSION W/ CONTRAST CBF
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
HCPCS 0042T 26
|
| Hospital Charge Code |
5220076
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$43.95 |
| Max. Negotiated Rate |
$234.40 |
| Rate for Payer: Aetna of NY Commercial |
$190.45
|
| Rate for Payer: Aetna of NY Medicare |
$134.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$117.20
|
| Rate for Payer: Cash Price |
$219.75
|
| Rate for Payer: CDPHP Medicare |
$108.41
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$234.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$234.40
|
| Rate for Payer: EmblemHealth Medicaid |
$234.40
|
| Rate for Payer: EmblemHealth Medicare |
$99.62
|
| Rate for Payer: Fidelis Medicare |
$117.20
|
| Rate for Payer: Galaxy Health Commercial |
$190.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$117.20
|
| Rate for Payer: Humana Medicare |
$117.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$190.45
|
| Rate for Payer: Local 1199SEIU Medicare |
$134.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$219.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$164.96
|
| Rate for Payer: MVP Health Care of NY Medicare |
$123.06
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$43.95
|
| Rate for Payer: United Healthcare Medicare |
$117.20
|
| Rate for Payer: WellCare Medicare |
$161.15
|
|
|
CT PERFUSION W/CONTRAST CBF
|
Facility
|
IP
|
$2,906.66
|
|
|
Service Code
|
HCPCS 0042T
|
| Hospital Charge Code |
4220076
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,889.33 |
| Max. Negotiated Rate |
$1,889.33 |
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,889.33
|
|
|
CT PERFUSION W/CONTRAST CBF
|
Facility
|
OP
|
$2,906.66
|
|
|
Service Code
|
HCPCS 0042T
|
| Hospital Charge Code |
4220076
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$436.00 |
| Max. Negotiated Rate |
$2,325.33 |
| Rate for Payer: Aetna of NY Commercial |
$1,889.33
|
| Rate for Payer: Aetna of NY Medicare |
$1,337.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,162.66
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: CDPHP Medicare |
$1,075.46
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$2,034.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,325.33
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,325.33
|
| Rate for Payer: EmblemHealth Medicaid |
$2,325.33
|
| Rate for Payer: EmblemHealth Medicare |
$988.26
|
| Rate for Payer: EmblemHealth Select Care |
$1,889.33
|
| Rate for Payer: Fidelis Medicare |
$1,162.66
|
| Rate for Payer: Galaxy Health Commercial |
$1,889.33
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,162.66
|
| Rate for Payer: Humana Medicare |
$1,162.66
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,889.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,337.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$2,179.99
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,636.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,220.80
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$436.00
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$1,162.66
|
| Rate for Payer: WellCare Medicare |
$1,598.66
|
|
|
CT SCAN FOR LOCALIZATION
|
Facility
|
IP
|
$2,640.00
|
|
|
Service Code
|
HCPCS 77011
|
| Hospital Charge Code |
4220073
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,716.00 |
| Max. Negotiated Rate |
$1,716.00 |
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,716.00
|
|
|
CT SCAN FOR LOCALIZATION
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
HCPCS 77011 26
|
| Hospital Charge Code |
5220073
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$124.15 |
| Max. Negotiated Rate |
$124.15 |
| Rate for Payer: Cash Price |
$143.25
|
| Rate for Payer: Galaxy Health Commercial |
$124.15
|
|
|
CT SCAN FOR LOCALIZATION
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
HCPCS 77011 26
|
| Hospital Charge Code |
5220073
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$28.65 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$87.86
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$76.40
|
| Rate for Payer: Cash Price |
$143.25
|
| Rate for Payer: Cash Price |
$143.25
|
| Rate for Payer: CDPHP Medicare |
$70.67
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$152.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$152.80
|
| Rate for Payer: EmblemHealth Medicaid |
$152.80
|
| Rate for Payer: EmblemHealth Medicare |
$64.94
|
| Rate for Payer: Fidelis Medicare |
$76.40
|
| Rate for Payer: Galaxy Health Commercial |
$124.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$76.40
|
| Rate for Payer: Humana Medicare |
$76.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$87.86
|
| Rate for Payer: MVP Health Care of NY Commercial |
$143.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$107.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$80.22
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$28.65
|
| Rate for Payer: United Healthcare Medicare |
$76.40
|
| Rate for Payer: WellCare Medicare |
$105.05
|
|
|
CT SCAN FOR LOCALIZATION
|
Facility
|
OP
|
$2,640.00
|
|
|
Service Code
|
HCPCS 77011
|
| Hospital Charge Code |
4220073
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,214.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1,056.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: CDPHP Medicare |
$976.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,848.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,112.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,112.00
|
| Rate for Payer: EmblemHealth Medicaid |
$2,112.00
|
| Rate for Payer: EmblemHealth Medicare |
$897.60
|
| Rate for Payer: EmblemHealth Select Care |
$1,716.00
|
| Rate for Payer: Fidelis Medicare |
$1,056.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,716.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$1,056.00
|
| Rate for Payer: Humana Medicare |
$1,056.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,214.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,980.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,486.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,108.80
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$396.00
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$1,056.00
|
| Rate for Payer: WellCare Medicare |
$1,452.00
|
|
|
CT SFT TSUE NCK W/O & W/DYE
|
Facility
|
OP
|
$1,595.00
|
|
|
Service Code
|
HCPCS 70492 TC
|
| Hospital Charge Code |
4220035
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$239.25 |
| Max. Negotiated Rate |
$1,276.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$733.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$638.00
|
| Rate for Payer: Cash Price |
$1,196.25
|
| Rate for Payer: Cash Price |
$1,196.25
|
| Rate for Payer: Cash Price |
$1,196.25
|
| Rate for Payer: CDPHP Medicare |
$590.15
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,116.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,276.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,276.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,276.00
|
| Rate for Payer: EmblemHealth Medicare |
$542.30
|
| Rate for Payer: EmblemHealth Select Care |
$1,036.75
|
| Rate for Payer: Fidelis Medicare |
$638.00
|
| Rate for Payer: Galaxy Health Commercial |
$1,036.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$638.00
|
| Rate for Payer: Humana Medicare |
$638.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$733.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,196.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$897.99
|
| Rate for Payer: MVP Health Care of NY Medicare |
$669.90
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$239.25
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$638.00
|
| Rate for Payer: WellCare Medicare |
$877.25
|
|
|
CT SFT TSUE NCK W/O & W/DYE
|
Facility
|
IP
|
$1,595.00
|
|
|
Service Code
|
HCPCS 70492 TC
|
| Hospital Charge Code |
4220035
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$1,036.75 |
| Max. Negotiated Rate |
$1,036.75 |
| Rate for Payer: Cash Price |
$1,196.25
|
| Rate for Payer: Galaxy Health Commercial |
$1,036.75
|
|
|
CT SOFT TISSUE NECK W/ DYE
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
HCPCS 70491 26
|
| Hospital Charge Code |
5220036
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$131.30 |
| Max. Negotiated Rate |
$131.30 |
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Galaxy Health Commercial |
$131.30
|
|
|
CT SOFT TISSUE NECK W/ DYE
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
HCPCS 70491 26
|
| Hospital Charge Code |
5220036
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$30.30 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$92.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$80.80
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: CDPHP Medicare |
$74.74
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$161.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$161.60
|
| Rate for Payer: EmblemHealth Medicaid |
$161.60
|
| Rate for Payer: EmblemHealth Medicare |
$68.68
|
| Rate for Payer: Fidelis Medicare |
$80.80
|
| Rate for Payer: Galaxy Health Commercial |
$131.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$80.80
|
| Rate for Payer: Humana Medicare |
$80.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$92.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$151.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$113.73
|
| Rate for Payer: MVP Health Care of NY Medicare |
$84.84
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$30.30
|
| Rate for Payer: United Healthcare Medicare |
$80.80
|
| Rate for Payer: WellCare Medicare |
$111.10
|
|
|
CT SOFT TISSUE NECK W/DYE
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 70491 TC
|
| Hospital Charge Code |
4220036
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$225.75 |
| Max. Negotiated Rate |
$1,204.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$692.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$602.00
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: CDPHP Medicare |
$556.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,053.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,204.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,204.00
|
| Rate for Payer: EmblemHealth Medicaid |
$1,204.00
|
| Rate for Payer: EmblemHealth Medicare |
$511.70
|
| Rate for Payer: EmblemHealth Select Care |
$978.25
|
| Rate for Payer: Fidelis Medicare |
$602.00
|
| Rate for Payer: Galaxy Health Commercial |
$978.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$602.00
|
| Rate for Payer: Humana Medicare |
$602.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$692.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,128.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$847.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$632.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$225.75
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$602.00
|
| Rate for Payer: WellCare Medicare |
$827.75
|
|
|
CT SOFT TISSUE NECK W/DYE
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
HCPCS 70491 TC
|
| Hospital Charge Code |
4220036
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$978.25 |
| Max. Negotiated Rate |
$978.25 |
| Rate for Payer: Cash Price |
$1,128.75
|
| Rate for Payer: Galaxy Health Commercial |
$978.25
|
|
|
CT SOFT TISSUE NECK W/O DYE
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
HCPCS 70490 TC
|
| Hospital Charge Code |
4220034
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$189.45 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$580.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$505.20
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: Cash Price |
$947.25
|
| Rate for Payer: CDPHP Medicare |
$467.31
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$884.10
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,010.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,010.40
|
| Rate for Payer: EmblemHealth Medicaid |
$1,010.40
|
| Rate for Payer: EmblemHealth Medicare |
$429.42
|
| Rate for Payer: EmblemHealth Select Care |
$820.95
|
| Rate for Payer: Fidelis Medicare |
$505.20
|
| Rate for Payer: Galaxy Health Commercial |
$820.95
|
| Rate for Payer: Hamaspik Choice Medicare |
$505.20
|
| Rate for Payer: Humana Medicare |
$505.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$580.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$947.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$711.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$530.46
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$798.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$189.45
|
| Rate for Payer: United Healthcare Commercial |
$798.00
|
| Rate for Payer: United Healthcare Medicare |
$505.20
|
| Rate for Payer: WellCare Medicare |
$694.65
|
|
|
CT SOFT TISSUE NECK W/O DYE
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
HCPCS 70490 26
|
| Hospital Charge Code |
5220034
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna of NY Commercial |
$1,076.00
|
| Rate for Payer: Aetna of NY Medicare |
$86.48
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$75.20
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: CDPHP Medicare |
$69.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$150.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$150.40
|
| Rate for Payer: EmblemHealth Medicaid |
$150.40
|
| Rate for Payer: EmblemHealth Medicare |
$63.92
|
| Rate for Payer: Fidelis Medicare |
$75.20
|
| Rate for Payer: Galaxy Health Commercial |
$122.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$75.20
|
| Rate for Payer: Humana Medicare |
$75.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,076.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$86.48
|
| Rate for Payer: MVP Health Care of NY Commercial |
$141.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$105.84
|
| Rate for Payer: MVP Health Care of NY Medicare |
$78.96
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$28.20
|
| Rate for Payer: United Healthcare Medicare |
$75.20
|
| Rate for Payer: WellCare Medicare |
$103.40
|
|
